1 / 29

Carcinoma of colon

Carcinoma of colon. Third most common type of cancer in men and women. Carcinoma of colon. Etiology: Diet- high protein , high fat diet, Fish, Beer, Low fibre diet : Intestinal bacteria

bsavoy
Download Presentation

Carcinoma of colon

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Carcinoma of colon

  2. Third most common type of cancer in men and women

  3. Carcinoma of colon Etiology: Diet- high protein , high fat diet, Fish, Beer, Low fibre diet : Intestinal bacteria :Genetic - siblings, children.FAP, HNPCC, PeutzJegher’s syndrome :Inflammatory bowel diseases :Radiation : Depressed immunity :Ureterocolicanastomosis

  4. Normal colonic mucosa>dysplastic aberrant crypt foci>early adenoma>intermediate adenoma>late adenoma>ca in situ>invasive ca • Tumour suppressor genes- APC gene, p53 gene, STK 11 gene. • Mismatch Repair Gene, microsatellite instability. • Oncogenes- k ras.

  5. Pathology • Adenocarcinoma(majority), undifferentiated carcinoma, neuroendocrine tumours, spindle cell tumour, squamous cell carcinoma, adenosquamous carcinoma • Common in distal colon: Sigmoid 21%, descending colon 5%, transverse colon12%, Ascending & caecum 25%, Each flexures 2% • Synchronous 3% and Metachronous 5%

  6. Gross: Polypoidal/ cauliflower, Ulcerative, Annular/stenosing, Diffuse infiltrating

  7. Microscopy: arise from the columnar epithelium or crypts of Liberkunh. Glandular formation. Varying degrees of differentiation (well, moderately, poorly).

  8. Spread • Direct- along mucosa and submucosa, surrounding bowel, bladder, peritoneum, anterior abdominal wall • Lymphatic- epicolic nodes, paracolic, intermediate, main lymph nodes, para aortic • Haematogenous- liver, lungs, adrenals, kidneys, bones • Transcoelomic spread

  9. Staging • Dukes: A- tumour confined to bowel wall B- spread beyond serosa to adjacent structures, no nodes C- Lymph nodes involved • TNM:Tx- primary cannot be assessed, T0- no evidence of primary, T1- tumour invades uptosubmucosa, T2- tumouruptomuscularispropria, T3- invades uptosubserosa or uptopericolic or pararectal tissue at unperitonealised area, T4- invasion of adjacent organ or perforation

  10. N0- no regional nodes, N1- 1 to 3 nodes, N2- metastasis to 4 or more regional nodes • M0 , M1

  11. Clinical Features • > 50 years • More in men • Depends on the site of tumour

  12. Caecum & Asc Colon • Asymptomatic • Anorexia, Anemia, Asthenia • Rt Iliac Fossa pain • Increasing constipation • Nausea, Vomiting • Blood and mucous in stools • Intestinal obstruction • Mass in RIF • Acute appendicitis • Intussusception

  13. Transverse colon • Vague symptoms • Constipation • Diarrhoea, Borborygmi • Intestinal obstruction

  14. Descending colon • Increasing constipation • Alternating constipation with diarrhoea- blood and mucous • Left sided abdominal pain • Mass abdomen • Abdominal distension

  15. Sigmoid colon • Progressive constipation • Pain abdomen • Tenesmus • Bleeding PR • Spurious diarrhoea • Sciatica • Perforation- peritonitis, paracolic abscess • Colo- vesical/ enteric/ cutaneous fistula

  16. Investigations • F O B • USG abdomen • Sigmoidoscopy/Colonoscopy, biopsy • Ba Enema • C T scan • I V P • C E A

  17. Treatment • Wide Resection or palliative resection/bypass • Preparation for surgery: Mechanical cleansing, Sterilisation of bowel (antibiotics), Hydration and electrolyte correction

  18. Operations • Right Hemicolectomy- tumours of Caecum, ascending colon • Extended right hemicolectomy- Hepatic flexure, transverse colon, splenic flexure • Left hemicolectomy- splenic flexure, descending colon, sigmoid • Anterior resection- sigmoid colon. • Hepatic resections • Colostomy- transverse/ sigmoid • Ileo transverse anastomosis

  19. Intestinal obstruction or perforations Lt side growth: primary resection, EEA , proximal colostomy/ Resection, end colostomy and mucous fistula/ Hartmann’s operation. Rt sided growth: Rthemicolectomy and primary anastomosis

  20. Chemotherapy- FOLFOX( 5 FU, Leucovorin, Oxaliplatin), FOLFIRI(5FU, Leucovorin, Irinotecan). Targeted therapy with bevacizumab (VEGF inhibitor) or cetuximab (EGFR inhibitor) in patients with k ras mutation. • Radiotherapy- no significant role.

More Related